Intergenerational transmission of health disparities among Turkish-origin residents in Germany: role of maternal stress and stress biology during pregnancy.

解决保健不平等问题的重要性是公认的。考虑到土耳其裔移民和德国本土移民之间代代相传的许多人口健康差异从生命的最初阶段开始就很明显，我们认为，这些健康差异的根源可能部分追溯到母亲在子宫内生命的关键时期对孩子发育的社会不利影响。我们提出了一个假设，即胎儿生命中与环境和时间不适当的社会不利相关的应激生物学暴露水平（母体-胎盘-胎儿（MPF）内分泌和免疫/炎症状态）可能会以一种影响随后健康和疾病风险相关结果的方式编程细胞，组织和器官系统的结构和功能完整性。作为解决这一假设的重要的第一步，我们试图阐明母亲迁移地位和社会经济地位（社会劣势的主要代理措施）对妊娠期间压力相关的MPF生物学过程的影响。我们建议在早期妊娠期间招募土耳其裔和德国裔孕妇进行前瞻性纵向研究。我们建议的一个独特优势是，目前正在招募1500名具有不同移民身份和社会经济地位背景的母子二人组（BaBi-study, BMBF grant 01ER1202, Jacob Spallek， PI）。该队列将根据0-4岁时的个体和环境因素以及儿童健康结果，对整个怀孕过程和产后进行特征分析。目前的提案要求资金增加在妊娠中期和妊娠晚期两个时间点对N=300名妇女（N=150名土耳其背景移民和N=150名德国本土妇女）的孕期内分泌（CRH，皮质醇）和免疫（CRP, IL-6）应激生物学的测量。我们已经组建了一支跨学科的研究团队，他们拥有互补的专业知识。我们的研究将产生关于德国土耳其裔居民健康的新信息，并阐明脆弱性代际循环的原因和机制。

The importance of addressing the issue of health disparities is well established. Based on the consideration that many of the population health disparities between immigrants of Turkish origin and native Germans that are perpetuated across generations are manifest from the earliest stages of the lifespan onwards, we posit that the origins of these health disparities may trace back, in part, to the effects of maternal social disadvantage on her child's development during the critical period of intrauterine life. We advance the hypothesis that context- and time-inappropriate levels of social disadvantage-related stress biology exposures (maternal-placental-fetal (MPF) endocrine and immune/ inflammatory state) during fetal life may program the structural and functional integrity of cells, tissues and organ systems in a manner that impacts subsequent health and disease risk-related outcomes. As an essential first step towards addressing this hypothesis, we seek to elucidate the effects of maternal migration status and socioeconomic status (the principal proxy measures of social disadvantage) on stress-related MPF biological processes across gestation. We propose to conduct a prospective, longitudinal study in a cohort of Turkish-origin and German-origin pregnant women recruited during early gestation. A unique strength of our proposal is the availability of a cohort of 1500 mother-child dyads of diverse background in terms of their migration status and SES (BaBi-study, BMBF grant 01ER1202, Jacob Spallek, PI) that is currently being recruited. This cohort will be characterized over the course of pregnancy and postnatally with respect to individual and contextual factors and child health outcomes at 0-4 years. The current proposal requests funds to add measures during pregnancy of endocrine (CRH, cortisol) and immune (CRP, IL-6) stress biology at two time points in the second and third trimesters of gestation) in a subgroup of N=300 women (N=150 immigrants of Turkish background, and N=150 native German women). We have assembled an interdisciplinary team of established investigators with complementary expertise. Our study will generate new information about the health of Turkish-origin residents in Germany and shed light on the causes and mechanisms of intergenerational cycles of vulnerability.